The aim of the present prospective study was to confirm that a significant impairment of the heart rate to workload relationship was consistently observed following unilateral and/or bilateral (sympathectomy) surgery.
Eur J Cardiothorac Surg 2001;20:1095-1100
http://ejcts.ctsnetjourna...i/content/full/20/6/1095

Cell body reorganization in the spinal cord after surgery to trea sweaty palms and blushing

The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

Monday, January 31, 2011

However, at each level of exercise, mean coronary flow in sympathectomized ventricles was reduced by about 50% compared to control values. The slopes of coronary flow on pressure-rate product and tension-time index were also reduced. No difference in left ventricular oxygen extraction between control and sympathectomized hearts were observed. Thus, chronic ventricular sympathectomy altered the relationships between coronary flow and oxygen consumption, on the one hand, and ventricular oxygen-dependent performance and whole-body exercise level, on the other hand.Med Sci Sports Exerc. 1988 Apr;20(2):126-35.http://www.ncbi.nlm.nih.gov/pubmed/3367747

The average percentage of the left ventricle denervated in the group I animals was 13.1% Â±7.3%.Significant reductions in oxidative metabolism were observed in the sympathectomized tissue both at 2 and 8 wk after surgery (22% and 15% reductions, respectively).

The baroreceptor reflex is only a short-term regulator of blood pressure because the receptors adapt by raising the threshold and lowering discharge rate.8. Describe the reflex compensations when someone suddenly stands up from a supine position. What would happen in a patient who just had a sympathectomy?

A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas.Australian Society of Anaesthetists 2002

With mid-thoracic lesions below the level of cardiac accelerator fibers, hypertension is accompanied by reflex bradycardia transmitted via cardiac accelerator fibers and the vagus. In patients whose sympathectomy is above the level of the thoracic cardiac accelerator fibers, tachycardia may occur because cardiac accelerator fibers become part of the efferent sympathetic activity rather than part of the central inhibitory input from the brain stem and hypothalamus. Arrythmias and occasional heart block may accompany changes in heart rate.Clinical manifestations of autonomic hyperreflexia include vasodilation, decresed sympathetic activity, and increased vagal activity above the level of the lesion such as nasal congestion, flushing, headache, dyspnea, nausea, and visceral muscle contraction. Vasoconstriction and increased sympathetic activity below the level of the lesion cause vasoconstrictive pallor, sweating, piloerection, and somatic muscle fasciculation. Patients also develop hypertension with headache, blurred vision, myocardial infarction, andretinal, subarachnoid and cerebral hemorrhages that may lead to syncope, convulsion and death.Handbook of Neuroanesthesiapage 343By Philippa Newfield, James E. Cottrell

The exercise capacity and the increase of coronary and systemic hemodynamics under treadmill exercise were studied in 5 dogs, chemically sympathectomized with 6-hydroxy-dopamine.

Completeness of adrenergic denervation was verified by stimulation of the right stellate ganglion, by intravenous administration of tyramine, and by demonstration of supersensitivity to exogenous norepinephrine.

These dogs demonstrated a retarded adaptation of hemodynamics to a sudden start of exercise. A fall in mean arterial pressure below 45 mmHg within 10 to 15 sec lead to collapse.steady state attainment of hemodynamic parameters was considerably delayed.

Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.

all regional hemodynamic changes after sympathectomy and suggest that the sympathetic nervous system may play an important role in reducing short-term hemodynamic variability.Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991Genetic Hypertension, by Jean Sassard

Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For bilateral procedures, a mean reduction of the heart rate of 12% was reported. Around 50% of patients have bradycardia in the following minutes of a bilateral surgery and mean and diastolic blood pressures significantly reduced.Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus.Interact Cardiovasc Thorac Surg. 2008 Nov 27. [Epub

Saturday, January 29, 2011

Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].

Sunday, January 16, 2011

Because of technologic advances and improved postoperative recovery, endoscopic surgery has become the technique of choice for many thoracic surgical procedures6 and 25; however, endoscopic visualization of intrathoracic structures requires retraction or collapse of the ipsilateral lung, which can have significant adverse effects on cardiopulmonary physiology. These cardiopulmonary changes can be further affected by the pathophysiologic changes associated with the disease process requiring the surgical procedure.

Because acute changes in cardiopulmonary function can compromise patient safety severely, a clear understanding of the dynamic interaction between the anesthetic–surgical technique and patient physiology is essential. This article discusses the effect of thoracoscopic surgery and the impact of various anesthetic interventions on cardiovascular and pulmonary physiology. In addition, some recommendations for “damage control” are made.

The amount of short- and long-term variability in heart rate reflects the vagal and sympathetic function of the autonomic nervous system, respectively. Therefore heart rate variability can be used as a monitoring tool in clinical conditions with altered autonomic nervous system function. In postinfarction and diabetic patients, low heart rate variability is associated with an increased risk for sudden cardiac death. A sympathovagal imbalance is also detectable with heart rate variability analysis in coronary artery disease and essential hypertension.http://www.annals.org/content/118/6/436.abstract

In conclusion, the results of the present study suggest a major role for the sympathetic nervous system in the regulation of regional circulations, the loss of which in sympathectomized rats results in a marked instability of MAP (mean arterial pressure). The vasodilator component of MAP lability after sympathectomy does not appear to depend on an episodic release of NO synthesized by the L-arginine pathway.

Genetic Hypertension: Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991

This study describes the ultrastructural changes in the sinuatrial and atrioventricular nodes of the heart of the monkey (Macaca fascicularis) after right cervical sympathectomy.Obvious changes in the nodal cells were seen one day after operation.Numerous glycogen particles grouped together to form electron-dense patches containing vacuoles in the cytoplasm. At three days after operation, intracellular organelles exhibited fragmentation and dissolution. By five and seven days after operation, the affected cells were vacuolated and some were swollen and appeared to have degenerated. Simultaneously, there was massive infiltration of macrophages were present nodal tissues. Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study.

In the majority of 16 non-cardiac and in two angina pectoris patients, unilateralor bilateral endoscopic transthoracic sympathectomy (method of Kux) was followedby signs of augmented cholinergic preponderance in cardiac dynamics (especiallyprolongation of the Isometric period of the left ventricle).

The findings obtained in 16 non-cardiac patients concerning the lengthof the isometric or tension period (TP), heart rate and pulse pressureare represented in Table 1.In response to transthoracic sympathectomy, all three parametersvaried from person to person in wide ranges in both directions. However,when the tests were repeated in the same patients at different time inter-vals after the operation (with or without a second contralateral syrn-pathectomy inbetween), their qualitative pattern of response (eitherupward or downward) remained the same in nearly all instances, asfar as the TP and pulse pressure were concerned. The responses of theheart rate, on the other hand, were less striking percentage-wise andvaried in quite an irregular fashion in identical individuals.No significant relationship existed between the magnitude of the pre-operative average values and the type (positive or negative) or degreeof the postoperative deviations in either one of the three recorded pa-rameters.

"Cardiovascular autonomic neuropathy (CAN) is the most prominent focus because of the life-threatening consequences and the availability of direct tests of cardiovascular autonomic function.. .CAN results from damage due to the autonomic nerve fibers that innervate the heart and blood vessels and results in abnormalities in heart rate control and vascular dynamics. Reduced heart variation is the earliest indicator of CAN."

"CAN is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests..."

These results support an association between CAN (cardiovascular autonomic neuropathy) and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.

The NA content in the heart was not measured but it is likely to be small at least at the 10-day period. It is known that three days after chemical sympathectomy NA content is only 7% of normal value [6]. Second, the development of adrenoceptor supersensitivity in the transplanted heart was demonstrated clearly with enhanced heart rate responses to NA or propranolol (at Day 10) [1]. As dennervation sensitization increases the arrhythmia susceptibility [6], it is thus possible that, in the presence of receptor supersensitivity, adrenergic activation occurs by either increase in circulating catecholamines and possibly local release of residual NA, which might still have been sufficient to contribute to arrhythmia development.Role of sympathoadrenergic mechanisms in arrhythmogenesisXiao-Jun Du* and Anthony M. DartBaker Medical Research Institute, Melbourne, Victoria, AustraliaCardiovascular Research 1999 43(4):832-834;

Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart ratein both pressor and depressor tests in the patients with palmar hyperhidrosis. We shouldnote that baroreflex response for maintaining cardiovascular stability is suppressed in thepatients who received the ETS.

"Although thoracic sympathectomy is commonly used to reduce upper limb sweating, it may also lead to facial anhidrosis and disturbed cardiovascular responses to temperature. The resultant effect on overall body heat loss has not been documented. We present a case of a young patient with previous thoracic sympathectomy who suffered severe heat stroke after heavy exercise.http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

Thoracic sympathectomy has been demonstrated to abolishor alter sympathetic vasoconstrictive responses in the skin,and this may contribute to abnormal peripheral vascular responsesto temperature [4]. Paradoxically it has been suggested thatin some cases there may be abnormal vasoconstriction rather than the expected vasodilatation after sympathectomy [5].

Itis not impossible that such atypical peripheral vascular responsesto rising body temperature may have contributed to impairedheat loss during exercise or to an inappropriate response toshock on the development of the heat stroke.http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

Cardiac autonomic function in patients (n = 63) with primary focal hyperhidrosis and healthy controls (n = 28) was investigated by short-term frequency domain power spectral analysis of heart rate variability. The power of the very-low-frequency band (0.01-0.05 Hz) was significantly lower in patients with axillary hyperhidrosis than in controls. No differences between groups could be observed at investigation of the low-frequency band (0.05-0.15 Hz), which was a surprising finding because this band represents also sympathetic cardiac innervation. At the high-frequency band (0.15-0.5 Hz), which represents parasympathetic cardiac innervation, an interaction of type and position influencing spectral power was detected. Our highly interesting findings indicate that primary focal hyperhidrosis is based on a much more complex autonomic dysfunction than generalised sympathetic overactivity and seems to involve the parasympathetic nervous system as well.Eur Neurol 2000;44:112-116 (DOI: 10.1159/000008207)

In the head-up tilt study, R–Rintervals significantly increased after the surgery in the head-uptilt positions (P<0.05),> difference in the supine position. There is no significant differencein QTc and Twa before and after the surgery, both in the supineand the head-up tilt positions. There was no significant differencein the LF or HF before and after surgery, either in the supineposition or the head-up tilt positions. In the LF/HF, therewas no significant difference before and after surgery in thesupine position. However, the LF/HF in the head-up tilt positionswas significantly decreased after surgery (P<0.05).> suppression of ETS was recognized more obviously under the steeperhead-up tilt positions.Conclusions: The influences on the cardiacautonomic nerve system of the ETS of upper thoracic sympatheticnerve were seen to be of a lesser degree at rest. However, theresponse to sympathetic stimulation was suppressed after thesurgery.
Eur J Cardiothorac Surg 1999;15:194-198

The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60 ± 1.49% to 4.81 ± 1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90 ± 0.11 and 0.92 ± 0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54 ± 0.22 and 0.76 ± 0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.http://cat.inist.fr/?aModele=afficheN&cpsidt=14106877

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic and increased vagal tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.Int J Cardiol. 1999 Aug 31;70(3):283-92.

Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].Eur J Cardiothorac Surg 2001;20:1095-1100

These dogs demonstrated a retarded adaptation of hemodynamics to a sudden start of exercise. A fall in mean arterial pressure below 45 mmHg within 10 to 15 sec lead to collapse.steady state attainment of hemodynamic parameters was considerably delayed.

Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.

These results indicate that chronic surgicalsympathectomy of the heart can be successfully accomplished in the rat andguinea pig. Such sympathectomy induces a postjunctional supersensitivity inguinea- pig right atria which is qualitatively and quantitatively similarto that described previously for chronic treatment with reserpine.Bilateral surgical sympathectomy provides a valuable tool for futureinvestigations of the cellular basis of supersensitivity in the myocardium.

ETS is a relatively safe and simple procedure. However the side effects are possibly devastating. All physicians providing this service and all peoples preparing to undergo this treatment should know this well.Min-Huei Hsu (10 January 2005)

CMAJ 2005; 172: 69-75

Endoscopic thoracic sympathectomy is prohibited for patients under 20 years old in Taiwan

http://www.ncbi.nlm.nih.gov/pubmed/2988820?dopt=Abstract

The prolongation of the isometric (tension) period (TP) of the left ventricle which occurred in the majority (72 per cent) of all cases after unilateral or bilateral transthoracic sympathectomy (without or with unilateral or bilateral transthoracic splanchnicotomy) indicates a diminution of inotropic cardiac action.

Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed.Thorax. 1995 Oct;50(10):1097-100.

CONCLUSIONS: Compared to left side TS, direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO, CI and SV.Ann Chir Gynaecol. 2001

Both MAP 1 and MAP2were reduced after sympahtectomy (P < 0.05). Heart rate was reduced transiently after the sympahtectomy and returned to the baseline value. PaO2 was reduced in 10 min after each right lung ventilation (P < 0.05) and left lung ventilation (P < 0.05).

Since thoracoscopic sympathectomy can rarely cause a significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia, we concluded that invasive BP monitoring should be used for early detection of those complications and immediate arterial sampling.

Chronotropic incompetence, an attenuated heart rate (HR) response to exercise, is an independent predictor of cardiovascular mortality, but it is not known whether chronotropic incompetence is related to carotid atherosclerosis.

Sympathetic suppression of ETS was recognized more obviously under the steeper head-up tilt positions. Conclusions: The influences on the cardiac autonomic nerve system of the ETS of upper thoracic sympathetic nerve were seen to be of a lesser degree at rest. However, the response to sympathetic stimulation was suppressed after the surgery.

1999 European Jounal of Cardio-Thoracic Surgery

Thoracic sympathectomy in patients with essential hyperhidrosis causes a marked decrease of HR and MBP of the bilateral radial arteries and an increase of skin temperature of the ipsilateral palmar area. Reventilation of the collapsed lung for bilateral thoracoscopic T2-3 sympathectomy, causes a marked reduction in the arterial oxygen tension.

Moss et al

Endoscopic sympathetic block as a treatment for primary hyperhidrosis is associated with certainsequelae. The reported occurrence of side effects still varies in the literature. As the majority of patients

describe sequelae after sympathetic surgery, the frequency and importance of these persisting changes

are still underestimated. Patient's informed consent should include and define side effects like gustatory

sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.

Thus, the integrity of the SNS is an important factor in the management of anesthesia, as well as being important in an individual’s quality of life.

TES (transthoracic endoscopic sympathectomy) can alter the autonomic function of the cardio-vascular system.

Baroreﬂex control of the circulatory system was assessed by head-up tilt. They showed that heart rate responses to head-up tilt were signiﬁcantly reduced after TES, and that the prevalence of orthostatic hypotension was increased after TES. However, their study demonstrates only the short-term effects of TES.The detrimental effects of TES on SNS-mediated circulatory adjustments may be trivial or may disappear in the long term. Because TES is considered to be a highly effective treatment for palmar hyperhidrosis, the long-term side effects of this procedure should be vigorously examined.

2005, Circ J. - Nakamura et alThe effects of endoscopic transthoracic sympathicotomy (ETS) on plasma natriuretic peptides concentrations in humans were examined in order to elucidate the role of the sympathetic nervous system in their regulation. METHODS AND RESULTS: Thirty-seven patients with palmar hyperhidrosis underwent ETS. Cardiac functional indices were assessed by echocardiography, and plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations were measured before and after ETS. ETS caused decreases in heart rate, mean arterial pressure, systemic vascular resistance, and increases in left ventricular (LV) end-diastolic volume, stroke index, ejection fraction, and left atrial diameter. LV end-systolic volume and cardiac index remained unchanged. Following ETS, ANP increased from 10.7+/-5.9 to 24.7+/-16.8 pg/ml (p < 0.01), and BNP increased from 5.1+/-4.2 to 19.7+/-21.5 pg/ml (p < 0.01). From the multivariate regression analysis, ETS, age and gender were determined to be significant predictors of changes in the ANP and BNP

Cervico-thoracic ganglion: its clinical implications.

After TS, mean NA plasma levels are significantly decreased, whereas mean A are unchanged. We conclude that sympathetic overactivity in EH is limited to the upper dorsal sympathetic ganglia and that some of the cardiovascular and pulmonary effects that are observed after TS may be associated with the decrease in NA.

The circulation in the muscles, however, is unaltered or may even be reduced. It also appears that improved skin blood flow is on the thermoregulatory, not nutritive level. It seems that chronic surgical sympathectomy does not cause major changes in the vascular function of the forearm. Although the exact pathophysiological mechanism of blushing is still obscure,

HRV before and after sympathotomy

Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R- R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR in- terval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly.

Bilateral sympathectomy produced fatal heart block in a few of their experiments

Mendlowitz. Schauer, and Gross pointed out that the heart rate became slower after removal of the sympathetic chain, but this bradycardia was only temporary. Bilateral sympathectomy produced fatal heart block in a few of their experiments.

sympathectomy affects the heart, sweating, and circulation

heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region

Eur J Appl Physiol. 2008 Sep;104(1):79-86. Epub 2008 Jun 10.

decline in external heart work due to sympathectomy both at rest and under exercise

Mean arterial pressure and total peripheral resistance were significantly reduced at rest and during steady state of exercise as compared to controls prior to sympathectomy identical vO2, whereas CO remained unchanged.

The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.

http://www.springerlink.com/content/k2n6j4555g16x773/

Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH

CONCLUSIONS: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV (systolic peak velocity) was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences.

Sympathectomy results in a significant interference in regulatory processes of the body

"ESB (whether as ETS as ETSC or ELS) generally represents a substantial interference in regulatory processes of the body. Therefore decision for this operation requires that previously conservative treatments were made. An ESB is therefore at the end of a treatment history, and never at the beginning."

Dr. Christoph H. Schick, ETS surgeon, President of the International Society of Sympathetic Surgery (ISSS)

text has been translated by google from German

http://www.dhhz.de/index.php?page=8&subPage=&section=32

bradycardia and other cardiac complications are common side effects?

The most common side effects of sympathectomy are compensatory sweating, gustatory sweating and cardiac changes including decreasing heart rate, systolic-diastolic and mean arterial pressure. The mechanism of bradycardia and other cardiac complications that develop after thoracic sympathectomy are still unclear.

http://tipbilimleri.turkiyeklinikleri.com/abstract_54802.html

significant fall in left circumflex coronary flow due to sympathectomy

http://www.springerlink.com/content/k2n6j4555g16x773/

surgical sympathectomy a tool for investigations of the supersensitivity in the myocardium

significant impairment of the heart rate to workload relationship following sympathectomy

Several reports also demonstrate significantly lower heart rateincreases during exercise in subjects who have undergone bilateralISS [9–12] compared to pre-surgical levels. In spite ofthis high occurrence, recent reviews on the usual collateraleffects of thoracic sympathectomy still do not include thesepossible cardiac consequences [6].The aim of the present prospective study was to confirm thata significant impairment of the heart rate to workload relationshipwas consistently observed following unilateral and/or bilateralsurgery.Eur J Cardiothorac Surg 2001;20:1095-1100http://ejcts.ctsnetjournals.org/cgi/content/full/20/6/1095

RESPONSE TO SYMPATHETIC BLOCKADE DEPENDS ON THE DEGREE OF SYMPATHETIC TONE BEFORE THE BLOCK

Denervation of preganglionic cardiac accelerator fibres leaving the cord at T1-T5 results in minimal vasodilatory consequences. Changes however in heart rate, left ventricular function and myocardial oxygen demand may occur due to high thoracic epidural blockade and are discussed below.

The major determinant of heart rate is the balance between sympathetic and parasympathetic systems with the latter predominating. A high thoracic epidural anaesthesia (TEA) covering the cardiac segments (T1-T4) produces small but significant reductions in heart rate4-8. During cardiac sympathetic denervation, parasympathetic cardiovascular responses, including those involved in baroreflexes, may dominate.

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block. Anaesth Intensive Care 2000; 28: 620-635B. T. VEERING*, M. J. COUSINS† Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands and Department of Anaesthesia and Pain Management, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales

Muliptle organ failure as a consequence of elective sympathectomy

In the post-sympathectomy patient, the abnormalsympathetic skin response may lead to peripheral vascular failureor the reduced cardiac chronotropic response may impair thebody’s capacity to compensate for shock. These may havecontributed to the rapid development of shock and severe multipleorgan dysfunction syndrome in this patient. He had multiple organ dysfunction syndrome develop, with severerenal and hepatic failure, grade II hepatic encephalopathy,and disseminated intravascular coagulation. He responded remarkablywell to aggressive supportive measures including forced alkalinediuresis, and he was eventually discharged home after 1 month. The patient was previously a healthy, physically fit, nonsmoker.He worked as a body building trainer and led an active, sportylifestyle. The only significant medical history was that hehad received thoracic sympathectomy for axillary hyperhidrosis4 years ago at another hospital.

Thorascopic manipulation of the lung and mediastinal structures may result in cardiac arrhythmias. Electrical current from the cautery may ...

Devernvation supersensitivity following sympathectomy

There is, however, considerable risk of developing a post-sympathectomy pain syndrome that may be the result of a denervation supersensitivity of alpha receptors.www.mc.vanderbilt.edu/.../Complex%20Regional%20Pain%20Syndrome-1...

Paradoxically it has been suggested that in some cases there may be abnormal vasoconstriction rather than the expected vasodilatation after sympathectomy.ats.ctsnetjournals.org/cgi/content/full/84

significant decrease in sympathetic activity and increase in vagal activity

Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.

http://www.ncbi.nlm.nih.gov/pubmed/19258086

slowing of the heart rate usually occurs on the second to fourth day after sympathectomy

The rate fell to a level between 40 and 6o per minute, the maximal slowing usually occurring on the second to fourth day after operation. Consistent slowing of the rate was not observed after a unilateral thoracic sympathectomy of either side. While there was some recovery from the maximum bradycardia with the passage of time in most patients, relatively slow resting cardiac rates and failure of tachycardia to develop with postural hypotension or exercise persisted in all patients.

Skoog's12 work has shown that there are marked differences in the number and precise location of the accessory ganglion cells in the cervical region in different patients and on the two sides in the same patient. Annals of Surgery, 1949 October, Volume 130 Number 4